The role of perseverative thinking processes in paranoia - PowerPoint PPT Presentation

The role of perseverative thinking processes in paranoia. Dr. Kate Cavanagh University of Sussex, UK kate.cavanagh@sussex.ac.uk. It’s not what you think it’s the way that you think it.

Copyright Complaint Adult Content Flag as Inappropriate

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.

Download Presentation

The role of perseverative thinking processes in paranoia

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

In cognitive psychopathology research focuses on both the content of automatic thoughts, attributions and beliefs • But also on the way we respond to these thoughts (cognitive or ‘thinking’ processes) and the implications of this for further thoughts, feelings and behaviour • For example: if the idea ‘I look foolish’ crosses my mind – how I respond to that thought (focus on it, evaluate it, dismiss it or distract from it, argue with it etc) will have an effect on future thought content, how I feel and my behaviour over time.

Outline • Repetitive thought and repetitive negative thinking • Role of repetitive negative thinking processes in psychopathology • Hypothesised role of repetitive negative thinking processes in paranoia • Research programme exploring the role of rumination in paranoia • Questionnaire based study (correlation) • Lab based studies testing the causal relationship between rumination and the maintenance of suspicious and mistrustful beliefs in student sample • Conclusions, questions and future directions

Perseverative cognition • “The repeated or chronic activation of the cognitive representation of one or more psychological stressors” (Brosschot et al., 2006) • Description of repetitive negative thinking adopted in research relating to stress-related physiological activation and its health consequences

Summary • Significant evidence of a transdiagnostic role for repetitive negative thought (RNT) • RNT associated with many Axis 1 disorders • Evidence of a causal role for RNT in onset and maintenance of transdiagnostic distress • Is RNT relevant to psychosis / paranoia and persecutory delusions?

Repetative thought in psychosis • Limited research available • High levels of worry found in • Individuals with current persecutory delusions (Freeman & Garety, 1998; Startup, Freeman & Garety, 2008) • And, other presentations of psychoses (Morrison & Wells, 2007) • Association between rumination and negative symptoms • A relationship between rumination and measures of emotional withdrawal and stereotyped thinking, in participants with diagnosis of schizophrenia (Harariet al., 2009)

Rumination and psychosis • Idea of ‘rumination’ or ‘brooding’ as playing a role in paranoia has clinical face validity • Repetitive thinking about the meaning, causes and consequences of activated threat beliefs and anxious mood • But, little research has explored the role of rumination in persecutory or paranoid beliefs

Does rumination play a role in paranoia? • A questionnaire study investigating the relationship between rumination and paranoid ideation in a student sample* • Two lab-based studies investigating the effect of rumination (versus distraction) on a personal threat belief • 1. autobiographical memory of suspicious or mistrustful event (within subjects design) • 2. in vivo exposure to a ‘paranoia prime’ (between subjects design)

Relevance of non-clinical studies • There is a continuum of severity of paranoia in the general population (Os & Verdoux, 2003) • 15-20% regularly engage in paranoid thinking • Non-clinical and clinical paranoia are associated with the same risk factors (Freeman, 2007) • Presence of non-clinical paranoia increases likelyhood for a subsequent diagnosis of psychosis • Non-clinical paranoia is of interest in its own right, but may also inform our understanding of clinical paranoia and persecutory delusions

Does rumination on paranoid ideation increase conviction in paranoid ideas and feelings of paranoia?Simpson, McGregor, Dudley, Cavanagh (under review) • 25 University Students • 22 females, mean age 20 (SD=3), 96% white • Autobiographical memory procedure • “Bring to mind a time when you felt suspicious or mistrustful of another persons intentions…” • “focus on the events that made you feel suspicious or mistrustful” • Within subjects design • With that memory held in mind think about…(counterbalanced) • Rumination (e.g. ‘Why people treat you the way they do’?) • Distraction (e.g. ‘the layout of your local supermarket aisles’) • Based on Rusting & Nolen-Hoeksema (1998) • Measures of procedure fidelity and adherence, conviction in threat beliefs, self-reported distress etc

Thinking tasks • Rumination induction • 15 rumination items and asked to spend 8 minutes thinking sequentially about the meaning of the items. • e.g. “Think about why people treat you the way they do” and “Think about how you react to other people • Distraction induction • 15 externally-focused distraction items • e.g. “Think about the layout of the local post office” and “Think about a double-decker bus driving down the street” • All items were taken from Rusting and Nolen-Hoeksema, (1998) rumination procedure. • Matched for instructions and length of task

Conclusions • Rumination appears to be associated with the maintenance of threat beliefs and paranoid feelings following recall of an autobiographical memory characterised by suspicion/mistrust • Distraction appears to remediate threat beliefs and paranoid feelings • Next step – does rumination have a similar effect on paranoid threat beliefs in vivo?

Induction of paranoia • Previous studies have used different protocols to initiate in situ paranoia • Prevost et al (2010) – participants told there was a hidden goal to the study, their cerebral activity would be manipulated via electrical currents during the experiment, and were given the impression they were being observed from behind a one-way mirror (paranoia not measured) • Ellet et al.(2008) exposure to deprived urban environment (increased paranoia) • Ellett & Chadwick (2007) video camera observation during task (increased paranoia – but artifact of self-focus/social anxiety?)

Our paranoia induction procedure • Sit in a dark room for 5 minutes, facing a wall with back to door, after some time someone might come in and might interact with you in a mildly unpleasant way – e.g. pinch you, tickle you, say something unpleasant to you… • Demonstrated to elevate state paranoia in pilot studies.

Measuring state paranoia Freeman et al (2007) State Social Paranoia Scale – designed to capture participants responses to a ‘social’ situation • “someone was hostile towards me” • “someone had it in for me” • “I felt safe…” • “everyone was pleasant” etc Freeman et al have found that more than 1/3rd people report paranoid thoughts even when the social environment is neutral (2008)

Findings of Martinelli & Cavanagh study • Paranoia induction appeared to raise state paranoia (needs validation/replication) • Rumination on this ‘dark-room’ experience was associated with maintenance of feelings of paranoia • Distraction was associated with reductions in feelings of paranoia • Baseline paranoia was associated with baseline perseverative style, and response to the paranoia induction. • Other methodological factors did not account for the effects of rumination on final level of paranoid ideation

Conclusions • Rumination appears to be associated with maintenance (elevation?) of threat beliefs and feelings of paranoia associated with exposure to ambiguous/threatening interpersonal situations • Distraction appears to remediate paranoid ideas and mood (at least in the short term) • This replicates and extends a significant body of research supporting the transdiagnostic role of repetitive negative thinking processes • Limitations to these studies in terms of small sample sizes, use of non-clinical examples of suspicious threat beliefs etc

Questions • Does this have any implications for our understanding of clinical paranoia/persecutory delusions? • How can we reconcile evidence of both repetitive negative thinking and ‘jumping to conclusions’ reasoning biases in relation to paranoia and persecutory delusions? • How might we extend our knowledge of paranoia processes in non-clinical samples? • How similar are these measured effects to those found in ‘post-event processessing’ in social anxiety? • Other questions….

Future research should explore… • Bio-psycho-social mechanisms underlying the relationship between rumination and suspicious and mistrustful thinking in non-clinical populations • The role of repetitive thought in paranoid ideation in clinical populations • The impact of keeping rumination and other types of perseveration in mind when working therapeutically with suspicious and mistrustful thinking and paranoia in clinical settings • E.g. can RNT therapies offer benefit in this domain?